[TOVIS pilot study-Aftercare effects of teleophthalmological diagnostics in senior living]

Remote teleophthalmological examinations can reduce access barriers for nursing home residents; however, it is unclear to what extent an actual ophthalmological aftercare can be realized.

The acceptance of the model, aftercare participation rate and the reasons for not contacting a medical specialist when indicated were examined 6 months after a remote ophthalmological first examination during the TOVIS pilot study.

Residents in two nursing homes who had participated in the TOVIS pilot study were surveyed in writing 6 months after the first examination. Data were acquired on 1) utilization of a recommended ophthalmological follow-up examination, 2) reasons for not participating in a recommended ophthalmological aftercare, 3) assessment of the remote examination using a Likert scale. Descriptive statistics, χ²-tests and t‑tests were used for the analysis.

Of the 86 originally examined residents, 64 (participation rate 74%, mean age 82.6 ± 8.8 years, 60.9 % female) participated in the follow-up survey. The remote ophthalmological examination was broadly accepted, 83.6% assessed it as meaningful (≥ 8 on the 10-point Likert scale), 82.5% would participate again and 76.9% would recommend the offer to others. Although 52 residents received the recommendation of an ophthalmological follow-up examination, after 6 months only 14/52 (26.9%) followed this recommendation. Findings that required treatment were in particular vision-relevant cataract (50%), glaucoma (21%) and subretinal or intraretinal fluid (7%), which were predominantly (68.8%) previously unknown to those affected. The major reasons for the 38 residents who did not participate in the aftercare were no complaints (31.6%), no desire for treatment (23.7%) and problems with transport or accompanying persons (10.5%).

The remote ophthalmological model study showed a high acceptance among the participants but there was a clear discrepancy between the express recommendation and the actually realized consultation with a medical specialist. Neither the presence of potentially vision-threatening findings nor the urgency of the recommendation significantly increased the compliance for aftercare. Therefore, for the realization of the full benefit of teleophthalmological programs for residents of nursing homes for the aged, supplementary measures are necessary, such as patient-centered clarification, structured appointment management and logistic support for the continuation with a visit to the practice.